Monday, June 22, 2015
By Kay Castillo, Director of Advocacy, Policy, and Legislation

It was a long week at the NC General Assembly! Senate members released their spending plan late in the afternoon on Monday and wrapped Medicaid Reform into the mix. The Senate budget spends significantly less than the House and the Governor’s spending plan proposals- as much as $700 million less and is full of policy changes. Additionally, their proposal for Medicaid Reform is very different regarding the set up and bid for serving North Carolina’s Medicaid and NC Health Choice populations. The Senate voted on House Bill 97 2015 Appropriations Act on Wednesday and Thursday, sending it back to the House. The House and the Senate will now appoint a conferee committee to work on a final plan. With so many changes both in spending, policy development, and Medicaid Reform, it is unlikely a budget will be in place July 1st; the start of the State’s fiscal year. A continuing budget resolution will be signed to keep state government operating. As a reminder, last year’s budget was not signed into law until August 7th. We could be looking at a long summer full of negotiations.

What Social Workers need to know about the Senate budget:

Education

The Senate does not put money forward like the House for local school administrative units, regional schools, and charter schools to hire additional school psychologists, school counselors, and school social workers. NASW-NC supports the House Proposal.

Health and Human Services

Provides funds to purchase a child welfare case management system- not to be under NC FAST. (page 132) NASW-NC Supports

Does not cut or add additional money to the Home and Community Care Block Grant as the House’s proposal to restore cuts made last year. (page 157) NASW-NC supports the House proposal to restore cuts.

Expands foster care to age 21 (House expanded to age 19 but are in favor of raising it to age 21). (page 147) NASW-NC Supports

Provides funding for a contract with the Government Data Analytics Center to enhance and improve the coordination of services and information among agencies to improve protection and outcomes for children served through child welfare services. (page 152) NASW-NC Supports

Reduces single stream funding and replaces it with LME/MCO cash balance. LME/MCOs will have to use reserves to pay for services. This will be a major issue with access to services and is another hit at our state run Medicaid system. (page 161) NASW-NC Opposes

Eliminates funding for the Wright School, effective Oct. 1, 2015. The Wright School is a residential mental health treatment program for children with serious emotional and behavioral disorders. (page 164) NASW-NC Opposes

Eliminates funding for Alcohol and Drug Treatment Centers as recommended by the Program Evaluation Committee. The budget does provide funding to allow LME/MCOs to purchase ADATCs to continue providing these services. (page 163) NASW-NC opposes closure without a substantial solution to providing the services.

Provides for money from the sale of Dorothea Dix Hospital to go into the Mental Health Trust Fund as The Dorothea Dix Hospital Property Fund and funds must be appropriated by the General Assembly in order to be spent. The Senate assures us that funding will be spent on services. (page 162) NASW-NC supports money from sale going to direct services.

Justice and Public Safety

Spending for mental health services is significantly less. Provides funding to open 66 of the unopened beds at Central Prison as does the House budget. NASW-NC Supports

Does not fund behavioral health treatment units at eight close custody prisons as in the House proposal. NASW-NC Opposes

General Government

Achieving a Better Life Act (ABLE)- fully funded in the Senate budget as outlined in House Bill 556 which passed House Finance last Thursday. The ABLE Act creates tax-advantaged savings accounts- 529 Accounts- for persons with disabilities.During House debate, Republicans said the ABLE Act is the best thing they have done all session. (page 355) NASW-NC Supports

No across the board pay raises for state employees as established in the House budget. NASW-NC Opposes

Medicaid Reform

Creates the Health Benefits Authority to oversee Medicaid and NC Health Choice. The new Authority replaces the Division of Medical Assistance which oversees our current Medicaid system under Governor McCrory’s administration. The Authority will be run by an eight member board of directors. Six regions will be established and Provider Led Entities (PLE) can bid to cover a region with no more than two PLEs per region. A PLE can bid on multiple regions across the state. This plan also eliminates Community Care of NC (CCNC). Additionally, a Legislative Oversight Committee on Health Benefits Authority will be established and reports are to be made to this Committee. Per the timeline, the plan will be operational by August 2017. (page 179) NASW-NC supports a system that can be held accountable that maintains current behavioral health services while a statewide system is developed as to not disrupt current services. Under a new plan, patients should have access to appropriate and needed services and providers should not be discriminated against when contracting with PLEs.

Relevant Bills with action

House Bill 562 Amend Firearm Laws: One of the more controversial bills of the legislative session, the House debated on this bill for over four hours on Tuesday and six hours on Wednesday. Representative Pendleton ran an amendment to remove the provider section that sought to prohibit providers from asking clients about access to firearms. Originally, the bill would have fined a provider from asking but this was later watered down before it was finally removed from the bill completely. The removal of this section supports the work social workers do with clients without being burdened. The bill still allows for a concealed carry permit holder to remove a firearm from their vehicle on school property if they feel they are in imminent danger and can have an impact on people bringing firearms into schools. Additionally, a section that would have allowed legislators and staff members from carry concealed weapons at the legislative building was also removed. The bill now goes to the Senate for consideration.

House Bill 372 2015 Medicaid Modernization: The House’s plan for Medicaid Reform includes Provider Led Entities covering services in all 100 counties. Each Entity must cover at least 30,000 patients and ensure appropriate services. Behavioral health services, dentistry, care for dual eligible patients, and pharmacy services are all excluded from the plan. Under the plan, 90% of Medicaid recipients would be served within five years. The plan passed House Appropriations and will be heard on the floor this week.

House Bill 836 Election Modifications: This bill makes changes to election laws. However, as a surprise to many members, a measure that allows voters without an ID to cast an affidavit at the polls showed up in the bill without going through the committee process. The change is in response to groups saying that there are significant delays at the DMV offering free ID cards following 2013 legislation requiring IDs to vote. In order to do this, voters would be say they could not obtain photo ID because of eight broad reasons, including work schedule, lost or stolen ID, lack of transportation, or family responsibilities. The voter would then have to present alternative forms of ID, such as a utility bill, voter ID card, or the last four digits of their Social Security number and birth date. The bill now goes to the Governor for signature.

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